Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark.
BMC Nephrol. 2022 Mar 5;23(1):94. doi: 10.1186/s12882-022-02708-8.
Acute Kidney Injury (AKI) is a frequent and serious postoperative complication in trauma or critically ill patients in the intensive care unit. We aimed to estimate the risk of AKI following major emergency abdominal surgery and the association between AKI and 90-day postoperative mortality.
In this retrospective cohort study, we included patients undergoing major emergency abdominal surgery at the Department of Surgery, Zealand University Hospital, Denmark, from 2010 to 2016. The primary outcome was the occurrence of AKI within postoperative day seven (POD7). AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO)-criteria. The risk of AKI was analysed with a multivariable logistic regression. The association between AKI and 90-day mortality was analysed with a multivariable survival analysis.
In the cohort, 122 out of 703 (17.4%) surgical patients had AKI within POD7. Of these, 82 (67.2%) had AKI stage 1, 26 (21.3%) had AKI stage 2, and 14 (11.5%) had AKI stage 3. Fifty-eight percent of the patients who developed postoperative AKI did so within the first 24 h of surgery. Ninety-day mortality was significantly higher in patients with AKI compared with patients without AKI (41/122 (33.6%) versus 40/581 (6.9%), adjusted hazard ratio 4.45 (95% confidence interval 2.69-7.39, P < 0.0001)), and rose with increasing KDIGO stage. Pre-existing hypertension and intraoperative peritoneal contamination were independently associated with the risk of AKI.
The risk of AKI is high after major emergency abdominal surgery and is independently associated with the risk of death within 90 days of surgery.
急性肾损伤（AKI）是创伤或重症监护病房中重症患者术后常见且严重的并发症。我们旨在评估重大急诊腹部手术后发生 AKI 的风险，以及 AKI 与术后 90 天死亡率之间的关系。
在这项回顾性队列研究中，我们纳入了 2010 年至 2016 年期间在丹麦 Zealand 大学医院外科接受重大急诊腹部手术的患者。主要结局是术后第 7 天（POD7）内发生 AKI。AKI 根据肾脏疾病：改善全球结局（KDIGO）标准定义。使用多变量逻辑回归分析 AKI 的风险。使用多变量生存分析评估 AKI 与 90 天死亡率之间的关系。
在队列中，703 例手术患者中有 122 例（17.4%）在 POD7 内发生 AKI。其中，82 例（67.2%）为 AKI 1 期，26 例（21.3%）为 AKI 2 期，14 例（11.5%）为 AKI 3 期。发生术后 AKI 的患者中有 58%在手术的前 24 小时内发生。与无 AKI 的患者相比，发生 AKI 的患者 90 天死亡率显著更高（122/41（33.6%）比 581/40（6.9%），调整后的危险比 4.45（95%置信区间 2.69-7.39，P<0.0001）），且随着 KDIGO 分期的增加而升高。术前高血压和术中腹膜污染与 AKI 风险独立相关。
重大急诊腹部手术后 AKI 的风险较高，与术后 90 天内死亡的风险独立相关。
